If you’re starting a third-party administrator — or you’re an established TPA onboarding a client who called you with nothing but a spreadsheet — the question underneath the whole business is: what software does it take to actually run one?
A quick boundary first. This isn’t advice on TPA licensing, registration, bonding, or errors-and-omissions coverage. Those are questions for your legal and compliance advisors — not a software vendor, and not this article. What we can speak to is the platform: the software a TPA operates on, across every client on its book. Get that stack wrong and every new client is a fresh integration project instead of a switch you flip.
Here’s the stack — and why it usually isn’t one.
The seven systems it takes to run a TPA
1. Client and plan setup. Per-client plan builds — benefit designs, networks, fee schedules — plus the enrollment and elections layer members use. Every client you sign needs this configured. Bought separately: an enrollment platform like Employee Navigator or B-Swift on top of whatever administers the plan.
2. Eligibility and member management. The system of record across all your clients — members, dependents, coverage tiers, effective and termination dates — kept clean so claims adjudicate against the right coverage. Bought separately: a member system plus eligibility files shuttled between platforms per client.
3. Claims adjudication. The core of the business: claim intake, per-client plan-design application, pricing, cost-sharing, and real-time accumulators — configurable for each client’s plan, not hard-coded to one. Bought separately: a dedicated claims payer or repricer, often a base around $20,000 a month per published market benchmarks, before you’ve built anything client-facing.
4. EDI and clearinghouse. Electronic claim intake (837s), remittance generation (835s), and eligibility transactions with clearinghouse connectivity, so provider bills flow in and read cleanly across every client. Bought separately: a clearinghouse contract plus EDI middleware.
5. Billing and payments. Contribution and premium billing, provider disbursements, 1099-MISC and W-9 tracking — plus billing your own administration fees to each client. Bought separately: a billing platform, a payment gateway, and separate tax tooling.
6. Member and provider portals. Branded portals — ideally white-labeled to each client — where members pull EOBs, ID cards, and claim status, and providers check eligibility and submit bills. Bought separately: a custom portal build you maintain per client.
7. Communications and growth. Email, SMS and texting, a call center, enrollment funnels, and automations — both to serve your clients’ members and to win your next client. A TPA is a sales business as much as an operations one. Bought separately: a marketing platform, a phone system, and a funnel builder.
Why that’s normally five to seven contracts — per client
Buy those separately and every new client is an integration project: contracts, setup fees, and per-transaction fees on each system, middleware to make them talk, and protected health information scattered across seven platforms you now answer for. A standard claims-payer-plus-buildout can cost a base around $20,000 a month before you’ve onboarded anyone — the reason so many new TPAs stall before their first client and so many established ones can’t say yes to a small greenfield account.
That last part matters. The easiest client to onboard is the one with no legacy system to migrate — the new self-funded group, the captive, the association adding benefits, the client who called because they have a spreadsheet and nothing else. On a seven-vendor stack, that client is barely worth the setup. On the right platform, they’re a switch you flip.
Claimaro is all seven, in one — per client
Claimaro is the whole stack in a single platform: client and plan setup, eligibility and member management, configurable claims adjudication with real-time accumulators, EDI and clearinghouse, billing and payments, white-labelable member and provider portals, and the full communications and growth suite. Each client runs in its own isolated database, HIPAA- and SOC 2-compliant controls are built in with a BAA on every plan, and you spin up a new client environment in minutes, not an implementation cycle. Because there are no per-claim fees, you can run your entire book on it and upcharge the platform to your clients however your business model calls for — the transaction volume is yours, not the vendor’s.
Zero per-claim fees — ever. In a market where claims payers bill per transaction, Claimaro doesn’t. Your book can double, every client can have its busiest month, and your platform cost doesn’t move a dollar. For a TPA, that’s the difference between transaction volume being someone else’s margin and being yours.
If you’re weighing the incumbent claims platforms, we put Claimaro side by side with them — see how Claimaro compares. And the math usually decides it: replacing a $20K-a-month claims payer plus six more point systems with one platform, at published pricing from $3,500/month + $5 PMPM with no per-claim fees, is what lets a TPA say yes to the clients a seven-vendor stack forces it to turn away.
See the stack, and the number
The fastest way to understand it is to see it. Run the numbers in our calculator against what a seven-vendor stack would cost you per client, then book a walkthrough — twenty minutes, and we’ll show you a client running end to end in one place.